Walking back

It’s presumptuous to criticize members of a profession for acting “unprofessionally,” especially true when I have not acquainted myself with the specific norms of that profession. I did that when I said recently that some mental health professionals “are acting unprofessionally and to a certain extent dangerously in their public diagnoses” of Mr. Trump. Part of what I meant was that mental health professionals ought not to comment publicly on a public official’s mental health.

I no longer believe that. Dr. X–both in his comments here at Hit Coffee [for example] and in some posts at his own blog [here and here]–has convinced me that it’s sometimes appropriate for mental health professionals to make such public commentary and that whether or not it’s “professional” is more arguable than I allowed.

Cautions are still in order

I still urge caution when it comes to public diagnoses, but before I proceed, I’ll note a few terms I am probably using wrong, or at least too globally. “Mental health” and “diagnoses” here in this post are catchalls and may not necessarily encompass what public commentary on public officials is really about. “Mental health professional” is a broad term, too. It can include MD’s, PsyD’s, PHD’s, LCSW’s, and probably others–the key point is that I’m referring to people who are licensed or otherwise credentialed to counsel others or to people who study mental health academically. While my use of these terms is sloppy, I ask your indulgence.

Now, on to the cautions…

Caution #1: “can’t” is a sliding scale

It’s important not to confuse the general sense and professional norm that such commentary is “improper” with a strict prohibition against such public commentary. I understand the Goldwater rule is somehow encoded into the American Psychology Association’s code of ethics. I suspect, however, a mental health professional who offers public diagnoses does not usually risk being hauled before an ethics board or otherwise sanctioned in the same way he or she might by, say, inappropriately breaking confidentiality.

Anti-caution: We should presume that professionals take the established norms of their profession seriously. Even if they disagree with the norms and seek to revise or ask others to reconsider them, we should presume the professionals feel in some way answerable to those norms or at least believe the norms something that merit discussion and are not to be lightly disregarded. Even without a strong enforcement mechanism, these injunctions still act in some ways as a prohibition.

Caution #2: There is never enough information

I submit that any public diagnosis has to be upfront about what is not known and ought to be open to the concern that the diagnosis might be too hasty. In the meta-sense we just cannot see into other people’s minds. In the non-meta-sense, there’s always something we don’t know about others’ history or actions or influences.

Anti-caution: Thus is it always and everywhere. No matter how much is known there are always unknowns. And yet, we have to come to conclusions and mental health professionals are no different.

I am informed that in at least some cases, the mental health professional can diagnose an individual in a matter of minutes. I am also informed that in other cases, mental health professionals may be called upon to create psychological profiles of others whom they have never met (say, psychological profiles of employees or profiles of foreign leaders for state intelligence). And regardless of these examples, some persons’ actions do demonstrate what they are likely to do in the future, and if a mental health professional can yield discipline-specific insights into those actions that a layperson cannot offer, then that’s probably okay.

Caution #3: my corollary to the McArdle rule

Megan McArdle often says that just because there’s a problem doesn’t necessarily mean there’s a solution to the problem. My corollary is that just because a public diagnosis is correct doesn’t mean it tells us what to do with the person so diagnosed. (I’ll add here that a good model is Dr. X. He may offer opinions grounded in his area of expertise, but when he discusses policy solutions he takes care to distinguish what his expertise can and cannot tell us.)

Anti-caution: My corollary doesn’t mean such public diagnoses are worthless. A diagnosis might very well and very rightly warn us, for example, against false assurances that someone will “pivot.”

I believe that making these kind of diagnoses without the benefit of having a carefully constructed private relationship with the public political personality being analyzed leads many of the tens of millions of supporters of the political character who has been labeled in this way to believe that implicitly they too are being judged and dissed. This plays into a central problem facing us in the liberal and progressive world….When we use the kind of psychiatric labeling suggested by those who insist that Trump is a clinical narcissist, that is heard by many who support him as just a continuation of the way the liberal and progressive forces continually dismiss everyone who is not already on our side as being racist, sexist, homophobic, xenophobic, Islamophobic, anti- Semitic, or stupid. This makes many of these people feel terrible, intensifies their self-blaming, but then often generates huge amounts of anger at those who have made those judgments without ever actually knowing the lives and details of the people that are thus being dissed. And this contributes to the ability of right-wing demagogues like Trump (not a psychiatric term, but a political judgment) to win support by telling a deep truth to many Americans: “many on the Left know nothing about your lives, but they have contempt for you, think that if you are white or if you are a male you are specially privileged and should spend your energies learning how to renounce your privilege.”….

First, I should say my quotation is deceptive. The ellipses elide quite a bit. If you go back to read Lerner’s comment in full (I’m quoting from his point no. 4, but I recommend reading all his points), you’ll see his argument is not merely pragmatic, but enmeshed in a broader, ideological critique of the faults he finds with capitalism and meritocracy. I don’t necessarily share that broader critique and if I hadn’t elided those points, the quote would have been not only longer, but would have seemed more contestable as well.

Second, what Lerner seems to me to be saying (in part) is that however accurate a public diagnosis, it might elicit a stronger reaction and in the process do little good. His point is at least partially about prudence. We live in the world, and the world is going to react. It’s not fair, but that’s what will happen.

Anti-caution: We out not overlearn that lesson and make an idol of prudence. If someone speaks the truth, that is a value unto itself. The truth is an end. If that truth is commanded or informed by one’s professional memberships and professional training, then sometimes (maybe always?) it must be uttered and pursued, regardless of prudential considerations. And as Mike Schilling Over There has reminded me, the principal bearers of blame are those who don’t acknowledge the truth and those who create or pursue or gainsay the lies.

If you’re right, you’re right

I’ll probably never be comfortable with public diagnoses. But that said–and in contrast to a point I made very recently–those public diagnoses of Mr. Trump that I’ve seen seem to be correct. Even if they’re not correct, they’re correct enough. Mr. Trump’s actions have shown him to be a dangerous, petty man. So I’ll end where I began above. I retract my blanket statement that mental health professionals ought never issue public diagnoses of public figures.

About the Author

Gabriel Conroy (conroy, fka Pierre Corneille and corneille1640) is an ex-graduate student. Now he writes blogs! He has a solo blog--Ye Olde Republicke. The views expressed by Gabriel (or Pierre, or corneille1640) are his alone and do not necessarily reflect those of his spouse, employer, or his co-bloggers at Hitcoffee.

Prevailing theory assumes that people enforce norms in order to pressure others to act in ways that they approve. Yet there are numerous examples of “unpopular norms” in which people compel each other to do things that they privately disapprove. While peer sanctioning suggests a ready explanation for why people conform to unpopular norms, it is harder to understand why they would enforce a norm they privately oppose. The authors argue that people enforce unpopular norms to show that they have complied out of genuine conviction and not because of social pressure. They use laboratory experiments to demonstrate this “false enforcement” in the context of a wine tasting and an academic text evaluation. Both studies find that participants who conformed to a norm due to social pressure then falsely enforced the norm by publicly criticizing a lone deviant. A third study shows that enforcement of a norm effectively signals the enforcer’s genuine support for the norm. These results
demonstrate the potential for a vicious cycle in which perceived pressures to conform to and falsely enforce an unpopular norm re-inforce one another.

Several recent studies have investigated the consequences of racial intermarriage for marital stability. None of these studies properly control for first-order racial differences in divorce risk, therefore failing to appropriately identify the effect of intermarriage. Our article builds on an earlier generation of studies to develop a model that appropriately identifies the consequences of crossing racial boundaries in matrimony. We analyze the 1995 and 2002 National Survey of Family Growth using a parametr

If there is one thing in that statement which I would take issue with, it is Mallon’s overly optimistic belief that the new policy is “well-meaning”.

That’s because anyone who has spent any time in an Irish hospital over the last few years will have seen the smoking ban enforced in draconian and nasty ways which are simply punitive and judgmental.

Even those who have been fortunate enough to stay away from hospitals in that time can see the results of such bans.

Drive by the Mater on any rainy day, for instance, and you will see patients huddled together in their dressing gowns, exposed to the elements as they take a break from the drudgery of hospital life. This, apparently, is healthier than allowing the patients an enclosed area – which they used to have – where they could smoke without bothering anyone else and, perhaps, not get soaked to the bone at the same time.

People smoke in hospitals for a variety of reasons, and one which is never considered by the authorities is that it is actually good for their head.

Certainly, when my father spent a few years in and out of James’s hospital with the terminal, non-smoking related disease which would ultimately kill him, he measured the days by increments of when he’d go out for a smoke. It broke the endless monotony of living on a ward and, like many other long-term patients, he was determined to not become a ‘lifer’, one of those lost, institutionalised souls who simply lie in bed all day staring at the ceiling.

One might be forgiven for believing that this is more about sin and repentance than concern for the welfare of the sinners.

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Nothing written on this site should be taken as strictly true, though if the author were making it all up rest assured the main character and his life would be a lot less unremarkable.